Wednesday, June 15, 2011

and surgery to remove the chest tumor will occur next Thurs June 23. The surgery should only take 1-1.5 hours. I think I'm only in for an overnight stay.

So, here are my reasons:

1) Herceptin, while maybe slowing the growth of that tumor, is not shrinking it either.

2) Because I am due to start whole brain radiation in late June/early July, the earliest I would add a traditional chemotherapy (which MIGHT shrink the tumor) would be late July/early August. In the meantime, the damn thing would continue to grow in small increments.

3) We don't know for sure that chemo will shrink the tumor. If the wound in my armpit is any indication, it might shrink it temporarily (and remember that was helped along by the immunotherapy I received) but then it grew again. By the time I finally got into surgery for the armpit, the damn thing was 15x12cm large. So, if we wait to do chemo for two months, that puts me into late September. That means this tumor would have 3+ months to grow. I think it's grown maybe 0.5 to 1cm in one month. It could potentially be 3cm larger by the time we decide that chemo hasn't worked. So, I'd end up with a much larger wound than I would have now.

4) I don't have any faith that chemotherapy will actually shrink the tumor. I think going on Abraxane, while temporarily helping, damaged my immune cells (those Herminator t-cells) too much, subsequently allowing the armpit tumor and the brain tumors to grow. I still am not sure if my immune system is fully recovered from it. I have more faith in my own immune system to fight this thing, so I want to do what I can to support my own immune system. I once read part of a book that discussed statistics associated with chemo and I ended up thinking that while you might read something like 33% of patients improved (or whatever the statistic), it said that you needed to look at the actually study - and some studies have small numbers of patients, like 10 or 20. I also know other metastatic breast cancer bloggers who have tried all sorts of chemo cocktails, only to have their cancer progress. I don't want to get caught in that trap. It's not that I won't do chemo if I have to - I will. But at the moment, I won't start a traditional chemo regimen for 6-8 weeks. I will only have targeted therapies.

5) So, it seems that now is the time to strike at the chest tumor, which started growing around February (I think). Nip it in the bud. The surgeon knows he won't get clean margins (as did the surgeon up in Portland). So, there will still be some cancer left deeper, like near the bone. But, to me, it seems that if we get rid of the bulk of the tumor now, then chemo might be more effective later, as there will be less cancer cells to deal with. At the moment, it's about 6x5cm. Something like that.

6) The surgeon, Dr. F., felt that it was more movable than it was the last time he felt it.

7) Dr. F. did warn me that I might end up with a bigger wound than I have there now. I reminded him that I had a large wound there for 11 months before reconstructive surgery with the TRAM flap - at that point, it was maybe 12x8 cm? I also said that I dealt with a really large wound in my armpit for months before the April 1 surgery - and even afterwards. But I also said that the wound care nurse said that the fact that the armpit is healing, slowly, but it's healing, is a good indication that this wound might eventually heal. It'll heal better with less cancer there, that's for sure.

8) That area has had radiation twice, so that is NOT an option. And, the tissue in that area has been compromised due to surgery and radiation, so chemotherapies are not as effective as they might be with healthy tissue. That's another reason why I don't think chemo will do the trick with this large a tumor.

I don't want to wait months only to see it grow like I did with the armpit tumor. So, he's agreed to do it. I hope that it is the right decision. But I figure I'd rather have an open wound with a depression in my chest than an open wound with a 2cm protusion. There will be less cancer there, which will help chemo keep things at bay and which will allow healing.